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WASHINGTON — Nearly three weeks after a train derailed in East Palestine, Ohio, spewing toxic chemicals into the air, water and soil, Biden officials are racing to find answers on how the disaster happened. But it’s also unclear what happens next for thousands of Ohioans who could now be sick — and who covers their care.

Ohio lawmakers from both parties have already demanded that Biden health officials step up their response and ensure health care through an obscure provision of the Affordable Care Act that promises Medicare to Americans exposed to certain environmental health hazards. But legal experts tell STAT that it seems unlikely that the provision would apply here and totally unclear how Ohioans would go about getting it.

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“It would not be easy to deem everyone in a particular geographic area such as East Palestine eligible for Medicare,” said Lawrence Gostin, a public health law professor at Georgetown University, who described a “cumbersome process” that would amount to each person applying for access and proving their exposure, unless the federal government set up an unprecedented pilot program to ensure broader coverage.

“It would take political will for [the Health and Human Services Department] to cover some, or even all, residents of East Palestine,” Gostin said.

The Biden administration isn’t providing answers, yet, despite repeated calls from HHS officials to take stronger action on environmental justice. A health department spokesperson declined to comment on the Obamacare provision, but pointed to several other ways the agency is offering support in East Palestine, including Centers for Disease Control and Prevention officials on the ground assessing toxic exposure levels.

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Questions about federal health agencies’ response come amid mounting criticism of the Biden administration’s response to the train derailment — backlash that Biden officials argue is turning an environmental disaster into a partisan debate.

The Environmental Protection Agency took over recovery operations earlier this week and ordered the train company, Norfolk Southern, to foot the bill for cleaning up toxins, including cancer-causing vinyl chloride. Transportation Secretary Pete Buttigieg landed in the town Thursday. And the Centers for Disease Control and Prevention began sending staff last Friday to assess contamination and communicate risk to residents.

CDC began sending staff after an official request from state officials, a spokesperson said.

The obscure ACA language promising Medicare to environmental hazard victims was slipped into the sweeping bill by then-Montana Sen. Max Baucus, a Democrat, who had a specific case in mind — longtime asbestos poisoning in Libby, Montana, that resulted in hundreds of deaths and an EPA emergency declaration after years of activist lobbying.

That focus could make it difficult or impossible to apply the ACA provision to other environment hazard situations, said Boston College of Law professor Mary Ann Chirba. The actual language specifies that people who can participate in the Medicare pilot program are those who resided “in or around the geographic area subject to an emergency declaration made as of June 17, 2009.”

That hasn’t stopped public health and environmental justice advocates from pressing the federal government to ensure health care to East Palestine residents.

There is some precedent for action. No federal health coverage provisions existed when pediatrician and epidemiologist Philip Landrigan was working at Manhattan’s Mt. Sinai in 2001, when two planes hit the World Trade Center, killing thousands and eventually causing lingering health problems in thousands more who inhaled harmful chemicals, cement powder, and other toxins.

What Landrigan, now director of Boston College’s Global Public Health Program, and other health workers first dubbed the “World Trade Center cough” turned into cancer for hundreds of first responders and nearby victims.

“We had to basically work with our congressional delegation in New York and New Jersey to get federal funds,” said Landrigan. “Hopefully something analogous will happen here. I don’t know.” That federal support for health care coverage was eventually formalized in the World Trade Center Health Program.

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